NHS flaws that led to Mid Staffs scandal

Perverse incentives at the heart of the NHS mean it is better for managers to
quietly run hospitals into the ground rather than admit they are failing,
according to an expert who helped uncover the Mid Staffs scandal.

Hospital managers had more to gain by overseeing the slow decline in quality of services, than flagging up problems, said Roger Taylor of Dr Foster.Photo: Getty Images

Roger Taylor, co-founder of the health information service Dr Foster, said chief executives of failing hospitals tended to cut costs, cross their fingers and “hope that no one notices” the decline in quality.

The risk of this leading to them losing job their was “troublingly remote”, he claimed.

By contrast, he said overspending to maintain services was liable to get a chief executive sacked, as was admitting that a department had to be cut or downgraded.

It was exactly this rationale that led to patients at Stafford and Cannock Chase hospitals receiving such appalling care between 2005 and 2009 that as many as 1,200 deaths may have occurred, said Mr Taylor.

On Wednesday Robert Francis QC, who chaired the £13 million Mid Staff public inquiry, is expected to give a damning critique of the institutional failings throughout the NHS that enabled the tragedy to take place.

Jeremy Hunt, the Health Secretary, will be under pressure to offer solutions to ensure there is no repeat.

Mr Taylor, whose firm helped devise the standardised measure of death rates that first picked up problems at Mid Staffordshire NHS Foundation Trust, said the Health Secretary had to address incentives that made managers “do the wrong thing”.

Writing for telegraph.co.uk, he explained: “What happens when a hospital like Mid-Staffordshire finds it is struggling to deliver a high quality service with the resources available?

“As an NHS chief executive in that situation, you could simply overspend and breach your targets – and quite likely lose your job.

“You could try to argue to re-organise services but you are likely to face considerable opposition from both clinicians and the public.

"Or you can just cut costs, cross your fingers and and hope that no-one notices if the standards of care deteriorate.”

He continued: “The frightening truth about the NHS is that the third of those options is the one that every incentive in the system is pushing you towards.

“Because the risk that a poor quality service will get identified quickly, and the risk of that having consequences for your career, remain troublingly remote.”

These same incentives still exist throughout the NHS, he said, even though it is now five years since the now defunct Healthcare Commission launched an inquiry into Mid Staffs.

He argued a “vacuum” existed in the NHS when it came to judging whether hospitals or services provided good care.

While the Care Quality Commission is meant to ensure minimum standards of care, it is regularly criticised for giving poor organisations its stamp of approval. Hospital board members often struggle to “hold doctors to account”, he added.

Mr Hunt recently proposed Ofsted-style ratings for hospitals, which Mr Taylor welcomed as “the right approach” to help make them more transparent.

“It’s an attempt to come to a judgement based on a lot of different data,” he said.

But he warned that NHS staff must not once more fall into the trap of viewing such a rating as a "target" or and an end in itself.